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OHIO CVS STORES, L.L.C.
DSH360132 Kettering Health Hamilton
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Covered Entity Details
Entity Name
Kettering Health Hamilton
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360132
Entity Address
630 Eaton Avenue
Hamilton, OH 45013
Medicare Provider Number
360132
Participating Start Date
1/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06083
28 N. BROOKWOOD AVE.
HAMILTON, OH 45013
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William E Villegas, Regional VP of Finance
(937) 723-3414
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2021
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